Healthcare Provider Details

I. General information

NPI: 1184554115
Provider Name (Legal Business Name): KERIN HAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CORLISS ST UNIT 9305
PROVIDENCE RI
02904-2457
US

IV. Provider business mailing address

PO BOX 9305
PROVIDENCE RI
02940-9305
US

V. Phone/Fax

Practice location:
  • Phone: 401-529-0622
  • Fax:
Mailing address:
  • Phone: 401-529-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1084
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: